Health ministers attending the 63rd World Health Assembly are locked in a vigorous debate on how best to combat counterfeit medicines.

The watchdog group, the Pharmaceutical Security Institute recorded more than 2,000 incidents of counterfeit medicines in 2009, an increase of more than nine percent from the previous year.

The Group's Director for Europe, Middle East and Africa, Ashley How, says the true scope of the problem is unknown. He says counterfeiters use many ruses to manufacture and move their products around the world.

"Most counterfeiters will, because if you think of the required skill that goes into the production of a medicine in order to fool the health authorities, to fool the public, to fool law enforcement, they have to be of a good quality ... So, therefore what they do not want are law enforcement after them too soon, and so they will often put the active ingredient into the actual production," How said. "So, therefore, the active ingredient has to move around the world."

The World Health Organization is finding it difficult to keep the debate at the assembly focused on the health impacts of counterfeit medicines.

Countries such as India and Brazil, which are major manufacturers of generic drugs, accuse the pharmaceutical industry of using the issue of counterfeit drugs to protect their patents against generic competitors.

They say the World Health Organization is helping this effort. The Director of WHO's Essential Medicines Program, Hendrick Hogerzeil, refutes these charges.

"Our stated goal is very clear," Dr. Hogerzeil said. "We do not want any counterfeit discussion to block the trade in, what we call, legitimate generic medicines and WHO is not going in IPR [Intellectual Property Right] enforcements. We go for the public health and leave the other thing to WIPO (World Intellectual Property Organization) and WTO (World Trade Organization) and the countries themselves."

Dr. Hogerzeil says counterfeit drugs are sold in all countries. But he says rich countries are more successful at regulating and policing these sales than are poor countries.

"We are not so worried about, if I were to be honest about it, we are not so worried about falsified Viagra," Dr. Hogerzeil said. "We are worried about falsified malaria medicines, falsified AIDS medicines that poor people could buy that enter the markets and, in the end, do not treat the people and kill them."

Dr. Hogerzeil notes counterfeit medicines to treat these and other life-threatening illnesses are widely sold in Africa. A Nigerian delegate told the Assembly that a tainted teething syrup killed 84 children in his country last year.

The World Health Organization cautions consumers to be wary when buying medicines on the Internet. While some of the products sold are legitimate, WHO says many are not, and many can kill.